Provider Demographics
NPI:1487898003
Name:GORDON, TRICIA ANN
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PEBBLE CREEK CT
Mailing Address - Street 2:719
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5941
Mailing Address - Country:US
Mailing Address - Phone:214-600-4667
Mailing Address - Fax:
Practice Address - Street 1:6600 LBJ FREEWAY
Practice Address - Street 2:240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:214-600-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional